Key Message 5.
A child with diarrhoea should receive oral rehydration salts (ORS)
solution and a daily zinc supplement for 10–14 days. Diarrhoea medicines
are generally ineffective and can be harmful.

Made at home: ORS Solution A special drink for diarrhoea

Give the child a drink made with 6 level teaspoons of sugar and 1/2 level teaspoon of salt dissolved in 1 litre of clean water. Be very careful to mix the correct amounts. Too much sugar can make the diarrhoea worse. Too much salt can be extremely harmful to the child. Making the mixture a little too diluted (with more than 1 litre of clean water) is not harmful.

Diarrhoea usually cures itself in three to four days with rehydration (drinking a lot of liquids). The real danger is the loss of liquid and
nutrients from the child's body, which can cause dehydration and malnutrition.

A child with diarrhoea should never be given any tablets, antibiotics or other medicines unless prescribed by a trained health worker.

The best treatment for diarrhoea is to (1) drink lots of liquids and oral rehydration salts (ORS), properly mixed with clean water from a safe source,
and (2) take zinc tablets or syrup for 10–14 days.

What is ORS?

ORS (oral rehydration salts) is a special combination of dry salts that is mixed with safe water. It can help replace the fluids lost due to diarrhoea.

When should ORS be used?

When a child has three or more loose stools in a day, begin to give ORS. In addition, for 10–14 days, give children over 6 months of age 20
milligrams of zinc per day (tablet or syrup); give children under 6 months of age 10 milligrams per day (tablet or syrup).

Where can ORS be obtained?

In most countries, ORS packets are available from health centres, pharmacies, markets and shops.

How is the ORS drink prepared?

Put the contents of the ORS packet in a clean container. Check the packet for directions and add the correct amount of clean water. Too
little water could make the diarrhoea worse.

Add water only. Do not add ORS to milk, soup, fruit juice or soft drinks. Do not add sugar.

Stir well, and feed it to the child from a clean cup. Do not use a bottle.

How much ORS drink to give?

Encourage the child to drink as much as possible.

A child under the age of 2 years needs at least 1/4 to 1/2 of a large (250-millilitre) cup of the ORS drink after each watery stool.

A child aged 2 years or older needs at least 1/2 to 1 whole large (250-millilitre) cup of the ORS drink after each watery stool.

What if ORS is not available?

Give the child a drink made with 6 level teaspoons of sugar and 1/2 level teaspoon of salt dissolved in 1 litre of clean water.

Be very careful to mix the correct amounts. Too much sugar can make the diarrhoea worse. Too much salt can be extremely harmful to the child.

Making the mixture a little too diluted (with more than 1 litre of clean water) is not harmful.

Oral Rehydration Solutions

To prevent too much liquid being lost from the child's body, an
effective oral rehydration solution can be made using ingredients found in almost every
household.One of these drinks should be given to the child every time a
watery stool is passed.

Ideally these drinks (preferably those that have been boiled) should contain:

starches and/or sugars as a source of glucose and energy,

some sodium and

preferably some potassium.

The following traditional remedies make highly effective oral rehydration solutions and are suitable drinks to prevent a child from losing too much liquid during diarrhoea:

Breastmilk

Gruels (diluted mixtures of cooked cereals and water)

Carrot Soup

Rice water - Congee

A very suitable and effective simple solution for
rehydrating a child can also be made by using salt and sugar, if these
ingredients are available.

If possible, add 1/2 cup orange juice or some mashed banana
to improve the taste and provide some potassium.

Molasses and other forms of raw sugar can be used instead of white sugar, and these
contain more potassium than white sugar.

If none of these drinks is available, other alternatives are:

Fresh fruit juice

Weak tea

Green coconut water

If nothing else is available, give

water from the cleanest possible source(if possible brought to the boil and then cooled).

Instructions:
Mix well the rice cereal (or sugar), water, and salt together until the mixture thickens but is not too thick to drink. Give the mixture often by spoon and offer the child as much as he or she will accept (every minute if the child will take it). Continue giving the mixture with the goal of replacing the fluid lost: one
cup lost, give a cup. Even if the child is vomiting, the mixture can be
offered in small amounts (2-1 tsp.) every few minutes or so.

Banana or other non-sweetened mashed fruit can help provide potassium.

Continue feeding children when they are sick and to continue breastfeeding if the child is being breastfed.

Questions on Solutions made at Home

Q. How do I measure the Salt and Sugar? Different countries and different communities use various methods for measuring the salt and sugar.

Finger pinch and hand measuring, and the use of local teaspoons can be taught successfully.

A plastic measuring spoon is available from Teaching Aids at Low Cost (TALC) with proportions to make up 200 ml of sugar/salt solution.

Whatever method is used, people need to be carefully instructed in how to mix and use the solutions. Do not use too much salt. If the solution has too much salt the child may refuse to drink
it. Also, too much salt can, in extreme cases, cause convulsions. Too little salt
does no harm but is less effective in preventing dehydration. A rough guide to the amount of salt is that the solution should taste no saltier than tears. Q. How much solution do I feed? Feed after every loose motion. Adults and large children should drink at least 3 quarts or liters of ORS a day until they are well. Each Feeding:

For a child under the age of twoBetween a quarter and a half of a large cup

For older childrenBetween a half and a whole large cup

For Severe Dehydration: Drink sips of the ORS (or give the ORS solution to the conscious dehydrated person) every
5 minutes until urination becomes normal. (It's normal to urinate four or five times a day.)Q. How do I feed the solution?

Give it slowly, preferably with a teaspoon.

If the child vomits it, give it again.

The drink should be given from a cup (feeding bottles are
difficult to clean properly). Remember to feed sips of the liquid slowly. Q. What if the child vomits? If the child vomits, wait for ten minutes and then begin
again. Continue to try to feed the drink to the child slowly, small sips at a time. The body will retain some of the fluids and salts needed even though there is vomiting.Q. For how long do I feed the liquids? Extra liquids should be given until the diarrhoea has stopped. This will usually take between three and five days.Q. How do I store the ORS solution? Store the liquid in a cool place. Chilling the ORS may help. If the child still needs ORS after 24 hours, make a fresh solution.